Healthcare Provider Details

I. General information

NPI: 1700794518
Provider Name (Legal Business Name): LAVONIA SMILEY JORDAN PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 PAPILLION WAY
TALLAHASSEE FL
32309-7000
US

IV. Provider business mailing address

2450 PAPILLION WAY
TALLAHASSEE FL
32309-7000
US

V. Phone/Fax

Practice location:
  • Phone: 470-714-7945
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN201226
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: